AB1595 HOW DO WE PREVENT THE DEVELOPMENT OF MULTIMORBIDITY IN PEOPLE WITH INFLAMMATORY RHEUMATOLOGICAL DISORDERS: A QUALITATIVE INVESTIGATION
Authors: L. Grey, L. Bullock, C. A. Chew-Graham, C. Jinks, Z. Paskins, T. Rule, S. Hider
Journal: Annals of the Rheumatic Diseases (2023)

<h3>Background</h3> People with inflammatory rheumatological disorders (IRDs) are at high risk of developing multimorbidity, specifically cardiovascular disease (CVD) and mood problems. UK guidelines advocate annual reviews for people with Rheumatoid Arthritis (RA), although not other IRDs. Current healthcare reviews are often condition specific, focus on existing morbidities rather than identifying risk and preventing future illness, and may not include advice and support to change lifestyle behaviours. Before developing a healthcare review to prevent multimorbidity we sought to explore perspectives on existing healthcare reviews. <h3>Objectives</h3> To explore patients and healthcare professional (HCP) perspectives on healthcare reviews for people with IRDs at risk of multimorbidity. <h3>Methods</h3> People with IRDs were invited to take part in individual semi-structured interviews either by telephone or online platform. HCP perspectives (including primary and secondary care clinicians) were explored in online focus groups. These were transcribed verbatim. Inductive thematic analysis was undertaken (LG/LB). Data and codes were discussed, and key themes generated within the team. Ethical approval was obtained (REC Reference 22/PR/0162). <h3>Results</h3> 15 patients (7 male, 8 female, age 49-75) were interviewed. 3 focus groups were held with a total of 13 HCPs. Four themes were identified: content of a future review, preparing for the review, delivering a holistic review and outcomes. People with IRDs struggled to conceptualize a review which included risk of development of future conditions and wanted the review to focus on their IRD (e.g. joint assessment). People felt that current reviews felt like a 'tick-box' exercise. HCPs reported wanting to conduct a holistic review, highlighting challenges aligning patient and HCP agenda. People with IRDs also demonstrated variable attitudes to considering their risk of future conditions, ranging from whether they wanted all, some or no knowledge of their risk for other conditions influenced by whether these could be prevented. Preparation, such as written information or pre-review questionnaires were considered important to help people understand the review aims, align agendas and for the HCP to understand the patient history and context. Participants recognized the challenge of ensuring such materials consider underserved patient groups such as people with limited health literacy who may face difficulties accessing preparation materials. People with IRDs were flexible in considering whether a review should occur in primary or secondary care, whereas HCPs perceived primary care was best placed to provide a holistic approach although both groups agreed practitioner skills and expertise were more important than location. It was considered important to have outcomes from a review (including any actions to be taken by patient or HCP) clearly understood for a review to be perceived as beneficial. <h3>Conclusion</h3> People with IRDs are at high risk of multimorbidity and may benefit from healthcare reviews to address future risks. Such reviews need to be person-centered addressing both patient and HCP agendas to maximise utility and perceived value. Further research is needed to address how such reviews can be effectively implemented into routine care. <h3>Acknowledgements</h3> Project funded by West Midlands Clinical Research Network Improvement and Innovation Strategic Funding. <h3>Disclosure of Interests</h3> None Declared.